Sinusitis: A-to-Z Guide from Diagnosis to Treatment to Prevention

Introduction to sinusitis:

That runny nose and cough just won’t go away… Perhaps your child has a sinus infection. Sinusitis is a common problem in children. Nevertheless, it is often over-diagnosed in children with green runny noses, and missed in children who really have a sinus infection!

Curly haired boy with a plaid shirt. Sinusitis.

What is sinusitis?

The sinuses are small empty caverns in the bony skull. They are lined by mucus membranes and connect with the nasal passages. Some sinuses are present at birth; others continue to grow and develop for the first 20 years of life.

Sinusitis is the name given when the lining of one or more of these sinuses is red, swollen, and tender, the opening is blocked, and the sinus is at least partially filled with fluid (mucus and/or pus).

Technically, every cold is also a case of viral sinusitis. However, when doctors use the term they are usually referring to a bacterial infection in the sinuses.

Acute bacterial sinusitis has been present for less than three or four weeks; subacute bacterial sinusitis has been present for up to about ten weeks; and chronic bacterial sinusitis has been present for about ten weeks or more. The three may have different causes and treatments.

Who gets it?

Anyone can get a sinus infection. Colds or nasal allergies are usually present first. Sinus infections are also more common when there is exposure to cigarette smoke.

Children who have ear infections, GE reflux, cystic fibrosis, immune problems, deviated nasal septa, or poorly functioning cilia are more likely to develop sinus infections. Asthma and sinus infections often go together.

In addition, swimming, breathing cold dry air, or attending day care can predispose a child to sinusitis.

Boys get more sinus infections than girls.

What are the symptoms?

Adults and adolescents with sinusitis will often have headaches or facial tenderness to make the diagnosis clear. These are much less common in younger children. Instead, the symptoms are usually similar to a prolonged cold.

The common cold usually lasts about seven days. Within one to three days of the onset, the nasal secretions usually become thicker and perhaps yellow or green. This is a normal part of the common cold and not a reason for antibiotics.

If a child has both a cough and nasal discharge that do not improve within 10 to 14 days, this may be acute bacterial sinusitis. The nasal discharge may be clear or colored. The cough is present during the day, but is often worse during naps or at bedtime.

There may be a fever, sore throat from post-nasal drip, or bad breath. About half of the children also have ear infections (caused by the same bacteria).

Occasionally a child with severe acute bacterial sinusitis will have a headache, colored nasal discharge, high fever, and facial tenderness well before the normal 10 days typically used to diagnose sinusitis.

In subacute and chronic sinusitis, the symptoms are often minimal, but include the ongoing cough and nasal discharge.

Is sinusitis contagious?

In general, sinus infections are not contagious (although there have been rare outbreaks associated with swimming together). The colds that can lead to sinus infections are quite contagious.

How long does sinusitis last?

Sinus infections often last for weeks or months without treatment.

How is sinusitis diagnosed?

The diagnosis is often made based on the history and physical examination. Sometimes x-rays or CT scans are used to support the diagnosis.

How is sinusitis treated?

Acute and subacute bacterial sinusitis is usually best treated with appropriate antibiotics at an appropriate dose for the appropriate amount of time (usually 14-21 days). The antibiotics are usually continued for at least 7 days after symptoms disappear. If symptoms worsen or do not improve, the antibiotic is usually changed early in the course.

Saline nose drops may thin the mucus and speed healing. Decongestants may help symptoms, but usually do not speed healing. Antihistamines may thicken the mucus and slow healing.

Chronic sinusitis treatment usually lasts three weeks or more. For this reason, it is wise to obtain a culture of the infected material before treatment. Sometimes the infection is caused by fungus rather than bacteria.

Most children with chronic sinusitis (and to a lesser extent, subacute sinusitis) either have allergies or an ongoing irritant exposure, such as smoke or fumes. These should be identified and addressed.

How can sinusitis be prevented?

Breastfeeding lowers the risk of sinus infections.

Preventing sinus infections is possible. It involves the same proven measures outlined for preventing colds and ear infections.

In addition, changing swimming habits may be helpful for older children (avoiding jumping, diving, or swimming underwater – unless holding the nose or using nose plugs).

Immunizations, especially to pneumococcus, Haemophilus influenzae (Hib), measles, and the flu, are particularly important for children prone to sinus infections.

Finally, identifying and properly addressing allergies and irritants is the key to reducing the frequency, duration, and severity of sinusitis.

Dr. Alan Greene

As a father of four himself, Dr. Greene has devoted himself to freely giving real answers to parents' real questions -- from questions about those all too common childhood conditions to those that address the most recent and rare pediatric illnesses. His answers combine cutting edge science, practical wisdom, warm empathy, and a deep respect for parents, children, and the environment. He is also an electrifying public speaker, and has personally touched many during his talks in North America, Europe, Asia, and the Middle East.

Dr. Greene is a graduate of Princeton University and the University of California at San Francisco. Upon completion of his pediatric residency program at Children's Hospital Medical Center of Northern California he served as Chief Resident. He entered primary care pediatrics in January 1993.

Dr. Greene is the Past President of The Organic Center and on the Board of Directors of Healthy Child Healthy World. He is a founding partner of the Collaborative on Health and the Environment. He also consults for the Environmental Working Group.

In 1995, he launched, cited by the AMA as “the pioneer physician Web site” on the Internet. His award-winning site has received over 80 million Unique Users from parents, concerned family members, students, and healthcare professionals. In addition to being the founder of, he is the Medical Director for HealthTap.

In 2010 Dr. Greene founded the WhiteOut Movement to change how babies in the United States are fed. In 2012 he founded TICC TOCC - Transitioning Immediate Cord Clamping To Optimal Cord Clamping. He is also the founder of KidGlyphs, a free iPhone app that provides a tool for young children to express themselves beyond their verbal skills while teaching them important language skills.

Dr. Greene is the Founding President of the Society for Participatory Medicine and has served as both President and Board Chair of Hi-Ethics (Health Internet Ethics. He is on the Board of Directors for Healthy Child Healthy World, The Lunchbox Project, and The Society for Participatory Medicine. He has also served as an advisor to URAC for both their inaugural and their updated health web site accreditation program. He is a founding member of the e-Patient Scholars Working Group, and a founding board member of the Center for Information Therapy.

Dr. Greene is a regular columnist for Parenting Magazine. He is also the Pediatric Expert for The People’s Pharmacy (as heard on NPR) and Healing Quest (seen on PBS stations). He was the original Pediatric Expert for both Yahoo! and iVillage.

Dr. Greene is the author of Feeding Baby Green (Wiley, 2009), Raising Baby Green (Wiley, 2007), From First Kicks to First Steps (McGraw-Hill, 2004), The Parent's Complete Guide to Ear Infections (People's Medical Society, 1997), and a co-author of The A.D.A.M. Illustrated Family Health Guide (A.D.A.M., Inc., 2004). He is the medical expert for three additional books, The Parent's Soup A-to-Z Guide to Your New Baby, (Contemporary Books, 1998) The Parent's Soup A-to-Z Guide to Your Toddler, (Contemporary Books, 1999), and The Mother of All Baby Books, (Hungry Minds, Inc., 2002).

Dr. Greene is a frequent keynote speaker at important events such as Health 2.0 2011 held in San Diego, CA, IFOAM 2008 (International Federation of Organic Agriculture Movements), held in Modena Italy, the first European Internet health conference, held in Maastricht, the first International eHealth Association Conference, held in Jeddah, and the largest e-Healthcare World Conference, held in Las Vegas, and the first Green Power Baby Shower, held in Hollywood. Dr. Greene also appears frequently on TV, radio, websites, and in newspapers and magazines around the world, including such venues as the TODAY Show, Good Morning America, Fox and Friends, The Dr. Oz Show, CNN, ABC, CBS, and NBC network news, NPR, The New York Times, The Wall Street Journal, USA Today, Time Magazine, Parade, Parenting, Child, Baby Talk, Working Mother, Better Home's & Gardens, and the Reader's Digest.

Dr. Greene loves to think about challenging ideas, he enjoys being where nothing manmade can be seen, and he wears green socks.

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